Exploring Data and Metrics of Value at the Intersection of Health Care and Transportation Proceedings of a Workshop (2016) / Chapter Skim
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Appendix E: Structured Annotated Bibliography
Appendix E: Structured Annotated Bibliography
Pages 189-256
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E Structured Annotated Bibliography Appendix E contains an annotated bibliography of the literature found at the intersection of health care and transportation. This is staff-prepared as background material relevant to the workshop topic and is included for informational purposes only.
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190 INTERSECTION OF HEALTH CARE AND TRANSPORTATION Staff-prepared background material H Aryeh Cohen and Alina Baciu CONTENTS DESCRIPTION OF SEARCH STRATEGY 191 NONEMERGENCY MEDICAL TRANSPORTATION 195 BENEFITS OF TRANSPORTATION TO HEALTH CARE SERVICES, INCLUDING ACCESS AND MOBILITY 202 COST ISSUES, RESOURCE UTILIZATION 205 NEED FOR TRANSPORTATION, TRANSPORTATION AS BARRIER 209 HEALTH CARE REFORM, TRANSPORTATION REFORM, HEALTH EQUITY 229 HOW HEALTH CARE NEEDS INFORM TRANSPORTATION RESEARCH AND PLANNING 232 SYSTEMATIC REVIEWS AND LITERATURE REVIEWS 248 METRICS, VALUE, RETURN ON INVESTMENT 252
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Embase Search Strategy Keywords: transport or transit or taxi or Uber or Lyft or rideshare Combined with the index terms (including all sub-terms) : "cost utility analysis" or "cost benefit analysis" or "health care cost" or "cost effectiveness analysis" or "program cost effectiveness" or outcome assessment or outcome variable or adverse outcome or treatment outcome or health impact assessment or patient assessment or behavior assessment or social support assessment or "quality of life assessment" or prognostic assessment or community assessment Combined with any of these index terms (including all sub-terms)
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" OR "assessment") TRID Search Strategy Index terms: Medical services or Medical treatment or Medical trips or Health care or Health care services or Health care facilities or Medical examinations and tests or Therapy or Public health (brought up 710 results)
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Also searched index terms: Medical services or Medical treatment or Medical trips or Health care or Health care services or Health care facilities or Medical examinations and tests or Therapy or Public health Combined with these index terms: Economic and social factors or Economic factors or Economic conditions or Economic policy or Social factors or Social class or Socioeconomic factors or Impacts or Social impacts or Social service or Externalities or Public participation or Community action programs or Urban areas or Rural areas Results: 150 items, 30 were selected All the TRID searches were limited to the period 2006 to 2016. Google and Google Scholar Searches Searched for policy briefs, white papers, reports, and other examples of gray literature, using the search terms Health Care and Transportation, then added return on investment or value.
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194 INTERSECTION OF HEALTH CARE AND TRANSPORTATION • T ransportation was incidental to the research -- for example, if the study was controlling for access to transportation or a program was offering transportation vouchers to participants; or studies of case management interventions (which generally include arranging for trans portation services) or supportive services for specific health issues, such as HIV/AIDS • I nterventions were overly specific interventions or not generalizable, for the purposes of the present search, for example, transportation as a barrier listed by patients in a project that piloted lay-person screening for eye disease; a small survey (e.g., N = 23)
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This article provides one of the first empirical evaluations of this assumption as it relates to nonemergency medical transportation (NEMT) in the State Children's Health Insurance Program (SCHIP)
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The report explores NEMT services under both managed care and fee-for-service environments, presents unique profiles of state Medicaid transportation programs, and identifies innovative practices. In addition, the report highlights a number of innovative models that managed care and state organizations have adopted in order to improve access to medical services and to control costs and abuses.
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A goal of the study was to provide guidance for consistent access to non-emergency health care services by pointing the way towards coordinated non-emergency medical transportation services through a centralized transportation brokerage." Hanley, P
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A goal of the study was to provide guidance for consistent access to non-emergency health care services by pointing the way towards coordinated non-emergency medical transportation services through a centralized transportation brokerage." Kim, J., E
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The results of this initial study confirm that for this population additional transportation services are often not available and that more support for utilizing NEMT may be needed. Future research should evaluate persistent barriers, service delivery, and long-term outcomes." Musumeci, M., and R
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Prepared for: Transit Cooperative Research Program; Transportation Research Board, National Academies of Sciences, Engineering, and Medicine. To examine the effects of NEMT brokerage models on public transit, coordinated transportation services, access to Medicaid services, and general mobility, researchers conducted the case study research in accordance with the protocols approved by the TCRP Panel and Texas A&M's Internal Review Board for Human Subjects Research.
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In recent years, numerous state Medicaid programs have separated their transportation services from local or regionally coordinated transportation systems in order to create a statewide or regional brokerage for all NEMT trips. This approach is often pursued for cost savings, fraud deterrence, or administrative efficiency.
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Furthermore, modifications to national health care and transportation datasets are recommended to allow more direct assessment of this problem." BENEFITS OF TRANSPORTATION TO HEALTH CARE SERVICES, INCLUDING ACCESS AND MOBILITY American Public Transportation Association.
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RC offers a more diverse array of people-centered transportation services from travel training to volunteer driving, mobility management to fare relief, and neighborhood shuttles to non-emergency medical transportation. There is above all a strong emphasis on customer service and a culture of collaboration, as this article shows in an in-depth look at Ride Connection." Cohen, J
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As a stakeholder process, this occurs in theory by expanding the information base upon which public decisions are made. The extent to which this expanded information base represents public health professional and/or community health interests remains unclear.
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Failure to keep appointments potentially affects patients' health, disrupts the health care delivery system, and contributes to the poor utilization of resources. Further understanding of the reasons patients are unable to keep appointments can be useful in developing policy to address unmet patient needs and the effective delivery of health care services.
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National Center for Transit Research, Final Report 21177060-NCTR-NDSU03. "This study focuses on the qualitative and quantitative benefits of small urban and rural public transit systems in the United States.
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Transportation Research Board. http://altarum.org/sites/default/files/uploaded-publication-files/05_project_ report_hsd_cost_benefit_analysis.pdf (accessed September 20, 2016)
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is a barrier to health care, national transportation and health care surveys and datasets have not comprehensively addressed this link. The current study builds on earlier work that identified and described the population that lacks access to health care because of transportation barriers by examining the combined transportation and health care impacts of providing access to NEMT for those who currently lack such access.
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he mean distance subjects traveled to visit their center was 13.3 miles." The results indicated that residing more than 10 miles from the diabetes management center increased likelihood of poorly controlled diabetes, while those who lived within 10 miles of a diabetes center "were 2.5 times more likely to have improved their A1C values between their first and last office visits." Researchers emphasized the importance of provider awareness of transportation burdens for diabetes management and concluded that solutions include improved public transportation, more diabetes center locations in rural areas, telemedicine, or home visits. NEED FOR TRANSPORTATION, TRANSPORTATION AS BARRIER Abbott, P
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While health promotion interventions commonly target those health risks for everyone, people with disabilities are often left out of healthy people/community health initiatives. Barriers to participation include inadequate public transportation, inaccessible health care facilities or health screening equipment, discriminatory attitudes, poverty, and lack of knowledge.
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Other challenges included a lack of transportation and housing, and the need for socialization and social support. Latino older adults experienced their unmet needs in ways associated with their cultural background and minority status.
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This change will be felt strongly in rural areas, where the population is generally older and the supplies of health care services and alternative transportation are limited. The authors employed a mixed-method approach to assess health care accessibility among seniors in Vermont.
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The Atlantic, August 9. The article offers a personal vignette about a stranded discharged patient with no way to get home who is helped by a lucky coincidence, along with discussion of recent research documenting the great need for transportation -- often invisible to health care providers -- to routine health care services, especially in low-income and minority populations, who may have additional literacy and other barriers.
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Caregivers are important partners in adult day services utilization and in diabetes management. Targeting public funding for diabetes care within adult day centers is recommended." DeGood, K
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2003. A consensus statement on nonemergent medical transportation services for older persons.
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2001. Linkage to medical services in the Drug Abuse Treatment Outcome Study.
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2015. Travel by public transit to mammography facilities in 6 U.S.
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Median travel times by public transportation to the nearest facility for women with no household access to a private vehicle were obtained by ranking travel time by population group across all U.S. census tracts in each urban area and across the entire study area.
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Improving access to health care for uninsured elderly patients. Public Health Nursing 27(4)
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It highlights key findings of the report Understanding Community Health Needs in Iowa, "an analysis of the state's Community Health Needs Assessment and Health Improvement Plan, [in which] 41 counties identified access to transportation as one of their top 10 health needs." The report provides an overview for health sector leaders and practitioners of key issues in transit relevant to their work, from the way services are organized, to funding flows and needs, to planning and policy issues.
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Researchers found that young adults with Type 1 diabetes "had identifiable logistical barriers to accessing and maintaining contact with diabetes care services, which can be addressed with flexible service provision." Krupski, A., K Campbell, J
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It is divided among 7 chapters and 14 supplemental items. They are as follows: Introduction; Chapter 1 -- Transportation: The Critical Link to Health Care; Chapter 2 -- An Introduction to Community Transportation; Chapter 3 -- The Consumer's Search for Transportation; Chapter 4 -- Seniors' Needs for Medical Transportation; Chapter 5 -- Coordination: Working Together, Working Better; Chapter 6 -- Medicaid: America's First Medical Transportation Model at Work; Chapter 7 -- Special Needs Medical Transportation: Looking at Dialysis Transportation; Medical Transportation Supplement: Part A -- National Transit Resource Center Glossary; Part B -- Managed Care Terms and Methodologies; Part C -- Principles of Managed Care Contracting;
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The assessment, performed in accordance with Patient Protection and Affordable Care Act requirements, included the local public health agency, federally qualified health centers, school district, the local university, and key social services and nonprofit organizations, and a major local employer. Transportation to medical appointments surfaced as one of the four most frequently requested services between October 2009 and March 2012 in the three counties of the Muskegon area.
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. The fact sheet provides an overview of the services community health centers provide in rural areas, including meeting transportation needs.
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2005. Transportation barriers and health access for patient attending a community health center.
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The paper begins with a general discussion on the context of access barriers and their relationship to personal health. A review of the planning and medical research literature regarding transportation barriers to health care access follows with a description of community health centers and the study's objectives.
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of participants used the transportation services. No statistically significant differences in retention in, or use of, the mental health and substance abuse treatment program were identified by distance to the treatment site.
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Those respondents who used transportation other than a car had 3.23 times the odds of not keeping their appointment than those who did use a car to arrive at the clinic. The authors conclude that in Houston, where transportation costs are the highest in the nation and where the public transit system is small but expanding, finding an economical and reliable means to get to health care appointments may be a challenge for lower-income families."
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These patients were able to receive dental care within the past year. Dental schools can collaborate with social work schools to establish a protocol and assistance program for dental patients experiencing difficulty accessing care, thereby improving oral health status, retention rates, and dental student education." HEALTH CARE REFORM, TRANSPORTATION REFORM, HEALTH EQUITY Alley, D
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provides new but limited opportunities to promote or fund specialized transportation services for older people and adults with disabilities. This paper explains how states can use these largely untapped options to expand services for targeted low-income populations with mobility needs.
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. The California Endowment wassupported the Bay Area Transportation and Land Use Coalition to study the problem of transportation access and later to launch the Transportation Equity and Community Health (TEACH)
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(4) What unique transportation services are being implemented by CTCs to meet the increasing demand for non-Medicaid-funded dialysis trips.
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Transportation Research Record 2452:71–80. "A health impact assessment (HIA)
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However, established enrollees also reported 14 percent greater use of hospital inpatient and 9 percent greater use of emergency room care, as well as continued difficulty in accessing needed specialty and dental care services. Despite more (diagnosed)
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The model is a community–academic partnership among a federally qualified community health center, a rural health clinic, and the Medical University of South Carolina. Its aim is to improve access to and utilization of health care and social services to enhance the quality of life of older African Americans.
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The report provides an overview of The Kresge Foundation–supported project to address transportation barriers to health care access. The project undertook development and dissemination of six case studies, the convening of a policy advisory council, policy analysis, policy campaign, and training and technical assistance.
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2011. Factors affecting access to head and neck cancer care after a natural disaster: A post-Hurricane Katrina survey.
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This study estimated the impacts of transportation and travel distance on the utilization of health care services for older adults in rural and small urban areas. With data collected from a survey, a model was developed on the basis of the Health Behavior Model, which considered transportation and distance as factors that could enable or impede health care utilization.
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"Service delivery systems recommendations include increased social support systems, co-located and integrated services, and training of case managers to motivate clients to seek mental health and substance abuse treatment." Othieno, J
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Retention at 12 months was 81.5 percent. Successful strategies included partnering with community health centers, positive reinforcement and social supportiveness, monitoring progress, and free transportation.
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Reviewing the origins and evolution of the assurance and presenting the results of a 2009 survey of state Medicaid programs, the results of this analysis underscore Medicaid's unique capacity to not only finance medically necessary health care but also the services and supports that enable access to health care by low-income persons since Medicaid covers nonemergency medical transportation. This ability to both finance health care and enable its use moves to the forefront as Congress considers whether to
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Cases where citizens feel that there is unequal treatment by transportation services have been tested in court, especially where blatant cases of
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women missed an HIV medical appointment in the previous 12-month period, primarily due to their physical health and transportation limitations. Physical health and transportation problems were both the major barriers to accessing health services and the primary reasons for missing HIV care appointments among this population of HIV-infected women living in rural areas.
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2012. Reducing barriers associated with delivering health care services to migratory agricultural workers.
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:350–355. "Health care policy makers have cited transportation barriers as key obstacles to providing health care to low-income suburbanites, particularly because suburbs have become home to a growing number of recent immigrants who are less likely to own cars than their neighbors.
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The Antiretroviral Treatment and Access Studies included a mail survey of 176 HIV medical care facilities in four U.S. inner cities on clinic characteristics, services and practices, and patient characteristics.
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Greater investments in pedestrian and bicycle facilities may aid in offsetting adverse health outcomes by providing safe places to walk and bicycle. Coordination of human service and public transportation may also serve to mitigate some of the adverse conditions by improving access to health care facilities and other activities that improve mobility." Washington, D
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2015. Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: Results from a scoping study.
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. Mobility and social participation were both positively associated with proximity to resources and recreational facilities, social support, having a car or driver's license, public transportation and neighborhood security, and egatively associated with poor user-friendliness of n the walking environment and neighborhood insecurity.
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:976–993. "Transportation barriers are often cited as barriers to health care access.
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2008. No way to go: A review of the literature on transportation barriers in health care.
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The author concludes that transportation barriers prevent millions of Americans from accessing health care. These transportation barriers can be overcome by designing user-friendly, cost-effective interventions that achieve buy-in from the target community." METRICS, VALUE, RETURN ON INVESTMENT Clarke, P
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Both network and raster-based methods are often utilized for estimating travel time in a Geographic Information System. Therefore, exploring the differences in the underlying data models and associated methods and their impact on geographic accessibility estimates is warranted." This case study examined Limited Access Areas defined by Michigan's Certificate of Need (CON)
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, to help identify areas and communities where transportation shortages contribute to difficulty getting health care." HTSI is designed to "serve as a tool to guide users in the assessment of the most important factors associated with transportation barriers to child health care access. The HTSI factors are: 1)
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This report provides findings from an online survey of 104 health outreach professionals from community health centers across the nation. Transportation was one of the core themes, with a finding that 52 percent of respondents identified lack of transportation as a barrier for their clients.
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The research unveiled though that most states, regions, and local entities have more broadly included other types of customers and a broader range of transportation services and programs beyond "specialized" transportation services, including human services agency transportation and transportation services available to the general public. The research unveiled different levels of linkage functionality, including those linkages that provide service matching, trip planning, and even trip booking from customers' smartphones.
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